Sa health smoke-free policy
Functional groups Workforce - Occupational Health and Safety and Welfare
Summary This document directs al SA Health entities to implement the
SA Health Smoke-free Policy. The policy aims to protect the health of all persons entering the premises of SA Health entities by prohibiting smoking, and providing assistance to staff and consumers who wish to address their tobacco smoking.
Responsible Division Portfolio Executive, SA Health
Contact person Director Operations and Strategy, SA Health.
Applies to Department of Health - all Divisions / Branches / Units
All health units incorporated under the Health Care Act 2008 All hospitals incorporated under the Health Care Act 2008 SA Ambulance Service
Distributed to Department of Health - all Divisions / Branches / Units
All health units incorporated under the Health Care Act 2008 All hospitals incorporated under the Health Care Act 2008 SA Ambulance Service
Compliance with this Directive is mandatory
Department of Health Directive – SA Health
From 31 May 2010, smoking will be prohibited at all South Australian public health services and SA Health entities including all buildings, structures, outdoor areas, and government vehicles. This policy applies to all South Australian Department of Health employees, consumers, visitors, contractors and all other persons entering Department of Health premises. Temporary Exemptions may be provided to health services that have exceptional circumstances preventing them from implementing completely smoke-free environments by the commencement date.
All South Australian public health services will provide assistance to staff and consumers who wish to address their tobacco smoking. This includes providing information, advice and referral, as well as nicotine replacement therapies (NRT), where appropriate. Nicotine withdrawal management wil be provided for nicotine dependent patients who are unable to smoke tobacco while receiving an inpatient service.
PurposeThe purpose of the SA Health Smoke-free Policy is to:
> Protect the health of SA Health entity staff, consumers, contractors and visitors from passive smoking> Assist staff and consumers who wish to address their tobacco use > Provide a clear message to the community that all SA Health entities are committed to reducing the harm caused
by tobacco smoking by providing safe and health promoting smoke-free services.
> In Australia, the National Public Health Partnership has concluded that exposure to environmental tobacco smoke in
outdoor areas can produce symptoms of ill-health. This can particularly affect vulnerable individuals such as young children, pregnant women and people who suffer from pre-existing respiratory or cardiovascular conditions.
> The Chief Executive, Department of Health has a duty of care to provide a safe and healthy working environment
for all employees under the Occupational Health, Safety and Welfare Act 1986.
> SA Health entities recognise that active and passive smoking is hazardous to health, and that all those who enter
SA Health Premises should be protected from the involuntary inhalation of tobacco smoke. Given that there is no recognised safe level of environmental tobacco smoke exposure, prohibiting smoking is the most effective way to achieve a healthy environment at all South Australian public health services.
> Tobacco smoking is the leading cause of preventable disease and death in South Australia. It is responsible for 1,240
South Australian deaths each year and is associated with the annual loss of 77,000 hospital bed days. Reducing smoking prevalence reduces the burden of disease caused by tobacco and its impact on the health system.
> The South Australian Tobacco Control Strategy 2005-2010 sets out a number of actions to provide for cessation
support in public hospitals and health services, including identifying and treating all consumers using tobacco and reducing barriers for smokers to use cessation methods, such as nicotine replacement therapy.
> This policy is in line with South Australia’s Strategic Plan, Target 2 - Improving Wellbeing, through preventative
health action by reducing the percentage of young cigarette smokers by 10 percentage points between 2004 and 2014, and increasing the healthy life expectancy for South Australians.
> Occupational Health, Safety and Welfare Act 1986
> Tobacco Products Regulation Act 1997
> South Australian Tobacco Control Strategy 2005-2010
Policy ImplementationThe Chief Executive, Department of Health has responsibility for implementing this policy across South Australian public health services. Leaders across regions and individual health services, including Chief Executive Officers, Executive Directors, Directors, Managers, and Team Leaders have responsibility to implement the policy at the local level.
Chief Executive, SA HealthThe Chief Executive, Department of Health as responsible officer, has ultimate responsibility for the effective implementation of this policy. As far as is reasonably practicable, the Chief Executive must ensure that:
> all levels of management are aware of their responsibilities in relation to maintaining a smoke free workplace;> all employees, consumers, visitors and contractors are aware of their responsibilities in relation to this policy;> adequate resources are made available to implement this policy.
Chief Executive Officers, Directors, Executive Directors, Managers, Team Leaders and SupervisorsChief Executive Officers, Executive Directors, Directors, Managers, Team Leaders and Supervisors have direct responsibility for:
> implementing the policy’s strategies;> ensuring appropriate training and staff support is provided;> consultation with employees;> monitoring their staff to ensure compliance with this policy;> ensuring their staff are adequately informed about the policy and the penalties that could possibly be applied
> participating in the implementation of this policy;> complying with this policy and any local established procedures;> informing all those entering SA Health Premises of the policy where appropriate;> protecting their own health and safety at work and the health and safety of fellow workers;> ensuring that a cigarette break is taken in the employee’s own time ie, they are not paid breaks;> extinguishing their cigarettes before they arrive on SA Health Premises and reducing environmental waste and
cleaning costs by not littering (eg, put all butts in the bin.)
Each hospital and health service is strongly encouraged to form an implementation group to oversee the implementation and evaluation of the policy at the local level, and ensure that a consultative approach is used throughout the process. Each public health service region should consider forming a coordination committee to ensure that efforts are coordinated across services within its region.
Each public health service region is required to develop its own policy at the local level to implement the three main components of the SA Health Smoke-free Policy: procedures to identify and support consumers who wish to address their tobacco use; initiatives to support staff to quit smoking; and smoking restrictions across SA Health Premises. The purpose of this is to ensure that each health service complies with the policy in a way that addresses site specific circumstances, as wel as staff and consumer/patient needs.
The SA Health Smoke-free Policy applies to all persons entering SA Health Premises, including all SA Health entity (and administrative unit) staff and volunteers, students and researchers, as well as consumers, contractors and visitors. To comply with the policy, al hospitals, health services and administrative units must ensure that they implement the following components.
> All consumers are to be informed of the policy.
> All consumers are to be assessed for their tobacco smoking status and intention to quit when receiving a service.
> All (non-inpatient) health service consumers identified as smoking tobacco are to be provided with information about
options to quit, including referral to the Quitline, and offered access to at-cost nicotine replacement therapy (NRT).
> All inpatients identified as being nicotine dependent are to be offered assistance with nicotine withdrawal
management, including free NRT, or alternative pharmacotherapies and other supports as required for the duration of their inpatient stay.
> Upon discharge, all inpatients receiving quit smoking or nicotine withdrawal management support are to be provided
with access to pharmacotherapies (a co-payment may be required), quit smoking information and Quitline referral.
Interventions for consumers should be focused primarily on tobacco assessment and quit smoking support through information and counselling. Although NRT can be a useful intervention, it is to occur in conjunction with assessment and counselling, which most consumers will find helpful as a first line of support.
> All SA Health entities are to provide support to their staff to quit smoking, by providing free assessment, planning
and individualised counselling through Quit SA. This is to be regularly communicated to all staff.
> A full course (eg 10-12 weeks) of NRT is to be made easily accessible, up to two times per year, for any staff
member assessed as being nicotine dependent. This is to be provided to staff at cost price through existing pharmacy budgets of each health service or administrative unit. To access NRT, staff need to register with a quit support program through Quit SA or SA Health.
> Quit smoking support is to be made available to any SA Health entity staff member as part of Employee Assistance
> The availability of alternative pharmacotherapies for staff will be investigated and considered as potential future
Smoke-free EnvironmentsFrom 31 May 2010 smoking wil be prohibited at al South Australian Department of Health services, including all buildings, structures, outdoor areas, and government vehicles. This applies to al persons entering any SA Health premises, including the entire outdoor area. All new contracts (eg lease agreements and service provision agreements) entered into with SA Health entities wil stipulate that smoking by any of the parties or their contractors on SA Health entities premises is prohibited. The policy also extends to lessees who lease premises from SA Health entities (in the absence of any express exemption in their contract).
The mandatory guidelines for all SA Health entities are as follows:
> Clear and consistent signage is to be displayed prominently on and in all SA Health Premises, including the
boundaries of premises, and must communicate the Policy, stating clearly that smoking is not permitted.
> Appropriate cigarette disposal bins are be provided at the boundaries of all SA Health Premises, and designated
areas, at the discretion of each health service.
> All contracts that engage the work of contractors, including lease agreements for services such as cafeterias, will
stipulate that smoking is prohibited and is a condition of the agreement.
> All advertisements and public notices for employment will state that SA Health is a smoke-free workplace.
> Staff who wish to smoke at work are able to do so only during their own time or during a recognised rest break,
and smoking must occur off SA Health Premises.
> Staff are not to supply consumers with tobacco products. No public health service is to pay for tobacco products for
> Staff can request consumers or others not smoke on the premises when making home visits. Staff may choose to
leave the home if smoking continues and may make alternative arrangements for the provision of services.
> Staff are not to smoke during their work hours in the presence of consumers and/or when representing their
employer in a public or educational role, whether on or off any SA Health premises.
> Where SA Health provides living accommodation for staff that is not on SA Health premises, staff are prohibited
from smoking inside the property and it is preferable that they do not smoke within 7 metres of entrances, exits and ventilation points.
Temporary ExemptionsThrough the policy consultation process, selected health services were identified that may need to address a unique range of issues in order to comply with the policy. Due to these specific and unique circumstances the fol owing SA Health services may apply for a Temporary Exemption to the Smoke-free Environments component of the SA Health Smoke-free Policy in order to achieve ful compliance: short stay voluntary mental health services and country aged care services. Any application from these services will need to include a plan of what will be done to meet the policy if given a temporary extension of time to implement this policy. This will provide the exempted facility with an increased transition period prior to going completely smoke-free.
A Temporary Exemption entitles these selected SA Health facilities to nominate a place within their premises that is a designated outdoor smoking area for consumers only. Smoking is al owed within this designated outdoor smoking area at any time during the exemption period which can be up to 12 months in duration. Any temporary exemption will need to be reviewed prior to its completion by the health facility.
Criteria for ApprovalTo qualify for a Temporary Exemption a health facility must be, or have on its premises, a specific facility such as a short stay voluntary mental health services or country aged care services. Approval for a Temporary Exemption wil be based on the need of each facility to address issues of occupational health, safety and welfare, consumer residency, and service delivery. Only one designated outdoor smoking area is permitted for each SA Health premises.
Requests for Temporary Exemptions must be made in writing to the Chief Executive, Department of Health. If a Temporary Exemption is granted, the following conditions will apply.
> Be adjacent to the exempted facility and used only by consumers of the exempted facility.
> Be away from group sitting areas.
> Be at least 7 metres away from building entrances, exits, windows and ventilation points, food preparation and
serving areas, and hazardous substances and equipment.
> Display clear signage communicating conditions of use.
> Only be used by up to two consumers at one time.
> Be away from the general view of the public.
> Not be in an enclosed area (see Definitions).
> Not be used by staff, visitors or contractors.
> Not be used as an area to consume food and drink.
A Temporary Exemption only entitles a facility to nominate and use a designated outdoor smoking area. It does not remove the responsibility to implement and enforce all other components of the Smoke-free Health Services Policy. During the period of a Temporary Exemption the facility should undertake the following activities:
> Ensure that all aspects of the current policy are in place and functioning to build experience and knowledge around
addressing tobacco within the health service.
> Develop procedures to enable the facility to ban smoking completely, including consultation with consumers and staff.
> Develop an implementation plan (including communication strategy) for going completely smoke-free.
Smoking must not be permitted on any other part of the SA Health Premises. A Temporary Exemption can be removed at any time by the Chief Executive, Department of Health if a designated outdoor smoking area is used in breach of the conditions.
ComplianceSA Health entity staff should inform consumers, visitors and contractors of this policy where appropriate. This should be achieved through an educative approach and breaches of the policy dealt with in a non-confrontational manner.
> All consumers and visitors who breach smoking restrictions are to be informed of the policy and asked to
comply. If the breach continues, the person may be asked to leave the premises and subsequent breaches are to be reported to a Supervisor or Manager, or to security staff/authorised officers. It is important that staff do not use a confrontational approach to achieve compliance with smoking restrictions and should avoid any situation where there is risk of violence or injury. Mental health and aged care consumers in breach of the policy can also be directed to a designated outdoor smoking area if the health service has a temporary exemption.
> Staff who breach the policy in the first instance are to be counselled by supervisors or managers, including clear
explanation of the policy. Quit smoking support is to be offered if appropriate. If further breaches occur, formal disciplinary action may be taken by the supervisor or manager in line with workplace procedures. All staff are to have information about how to address breaches of local policy included in the training provided by their employer.
> Contractors in breach of the policy will be made aware of the policy and asked to extinguish their tobacco product
or leave the premises to smoke. Subsequent breaches are to be reported by the health service to the contracted company’s management and cancellation of the contract may result.
> Fines for smoking in prohibited areas can be issued by authorised officers under the by-laws of incorporated
hospitals in accordance with the Health Care Act 2008
Crisis SituationsSA Health entities recognise that discretion is required when enforcing the policy for consumers and visitors in distress. If smoking takes place on SA Health Premises by consumers and visitors who are highly distressed, it is recommended that staff apply the policy in a flexible way that does not add further distress to the situation. During implementation planning, managers and staff are encouraged to discuss ways to address such situations appropriately.
Information and TrainingAll staff are to be provided with information on the three components of the policy; support for consumers; support for staff; and smoke-free environments. Training should be appropriate to the role of each staff member within the hospital, health service or administrative unit.
CommunicationThis policy is to be communicated to staff, consumers, contractors and visitors in line with the SA Health Smoke-free Policy Communication Strategy, which is available on r
EvaluationEach health service region has responsibility for evaluating the performance of the policy, including implementation and impact of each of the three policy components. Executive Director, Operations, SA Health wil provide a questionnaire to assist health services to undertake evaluation of the policy. To achieve this, it is important that each health service collects information on a regular basis, regarding the implementation of the policy.
Information should be collected regularly on the three policy components; support for staff, support for consumers, and smoke-free environments. Information should also be col ected on implementation as wel as enforcement. The information below should be collected by each health service to be reported on to Portfolio Executive, SA Health within 12 months after implementation.
> The numbers of training sessions provided and percentage of staff, students, volunteers, and others trained.
> The type of awareness raising strategies used to target different groups at your health service.
> The type of quit smoking support provided to staff. > The type of interventions and supports provided to consumers, and percentage of consumers routinely provided
support to quit smoking and/or manage nicotine withdrawal.
> The number of compliance and enforcement issues that arise as a result of the policy.
Grievances about the policy will be addressed in line with SA Health Grievance Procedures.
Enclosed a structure is considered to be enclosed if it is fully enclosed or partially enclosed by a ceiling/roof and walls such that the combined area of the ceiling (includes shade sails and umbrel as) and wal surface exceeds 70% of the total ceiling/wal area. An area without a ceiling/roof wil not be considered enclosed. Smoking is banned in all enclosed public places and workplaces under the Tobacco Products Regulation Act 1997
SA Health Premises means buildings, structures, outside areas and employer vehicles owned, leased, occupied or controlled by SA Health entities and the Department of Health.
Nicotine replacement therapy (NRT) means products designed for therapeutic use to replace nicotine obtained from smoking tobacco. NRT products are available over the counter in pharmacies and (in some forms) in supermarkets.
Passive smoking is the inhalation of second hand tobacco smoke, which is a combination of side-stream smoke from a burning cigarette and mainstream smoke exhaled by a smoker.
Pharmacotherapies refers to medicines that have been shown to be effective and are licensed for smoking cessation in Australia. Currently these are; Nicotine Replacement Therapy (NRT), Varenicline and Bupropion. The prescription medicines (Varenicline and Bupropion) are available on the Pharmaceutical Benefits Scheme (PBS). The PBS requires that these medicines be provided only in combination with quit smoking counselling.
Smoke means to smoke, hold, or otherwise have control over, an ignited tobacco product.
Smoke-free means that no smoking is permitted on the premises.
Staff, for the purposes of this policy, means all employees of SA Health entities, volunteers, students and those working on behalf of SA Health entities.
Tobacco product includes a cigarette, cigar, and cigarette or pipe tobacco.
Non-English speaking: for information in languages other than English, call the Interpreting and Translating Centre and ask them to call The Department of Health. This service is available at no cost to you, contact (08) 8226 1990.
Department of Health, Government of South Australia. All rights reserved. ISBN: 978-1-74243-116-1 FIS: 10038.2. Printed April 2010.
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